title: Infection control in a burn center.
abstract: No consensus has been reached on the ideal isolation technique to prevent hospital-acquired infection in the patient with burns. This study reports four 2-month consecutive periods of microbial surveillance in a burn center intensive care unit. Phase I, the first period of surveillance, demonstrated a unit-acquired colonization rate of 63%, with the marker organisms appearing at 4 to 8 days. Direct observation of isolation technique showed a 51% error rate. A mandatory educational session reviewing the high colonization rates, observed breaks in isolation technique, and principles of infection control failed to decrease the colonization rates as measured in phase II. A simplified isolation technique was adopted, which led to a decrease in unit-acquired colonization, from 63% to 33% in phase III from phase I values (p = 0.0514); and to a significant delay in inception, from 7.8 to 21 days, in those colonized with Pseudomonas aeruginosa (p less than 0.05). The simplified isolation technique decreased isolation costs over a 6-month period from $53,000 to $30,000. To confirm the decrease colonization rates from phase I to phase III, a fourth 2-month surveillance period was undertaken 6 months later. Phase IV demonstrated similar results to those of phase III.
authors.affiliation: Department of Surgery, Burn Center, Seattle, WA.
authors.forename: J J
authors.initials: JJ
authors.lastname: Lee
authors.forename: J A
authors.initials: JA
authors.lastname: Marvin
authors.forename: D M
authors.initials: DM
authors.lastname: Heimbach
authors.forename: B J
authors.initials: BJ
authors.lastname: Grube
authors.forename: L H
authors.initials: LH
authors.lastname: Engrav
mesh_terms: D002053:Burn Units / Q000458:organization & administration; D002056:Burns / Q000382:microbiology*; D003428:Cross Infection / Q000517:prevention & control*; D006801:Humans; D010348:Patient Care Team; D010356:Patient Isolation; D011795:Surveys and Questionnaires; D014861:Washington